Feeding of Premature and Low Birth Weight

The Low Birth Weight delivery is 28% (UNICEF,2014).Most of the Preterm, Low Birth Weight and Intrauterine Growth Retarded baby continue to be underweight and stunted and contribute to the prevalence of malnutrition.So, nutrition of these babies has to be given due importance.

CHOICE OF MILK TO FEED

"Breastmilk And Breastmilk" is the ideal feed for all newborn including LBW and the Premature baby.Mother’s own expressed breastmilk is the first choice. Given the importance of breastmilk next best option is Expressed Donar Milk from other lactating mother.

METHOD OF FEEDING

• At 28-31 week of gestation age,there is immature sucking efforts. So, Orogastric/Nasogastric tube feeding has to be done.
• At 32-34 week of gestational age,there is slight coordination of suck, swallow and breathing.So, spoon, paladi or cup feeding can be done.
• At 34 week of gestational age , there is good sucking, swallowing and breathing co-ordination.So breastfeeding can be initiated.

HOW TO EXPRESS BREASTMILK

Method to express breastmilk.

• The mother must wash her hands in 8 steps thoroughly.
• Place the 30ml measuring cup near the expressing breast.
• The mother should message the breast for 5-10 minutes before expressing milk in a circular motion towards the nipple like kneading dough gently using pulp of two fingers or with knuckle of the fist.
• Mother should press with thumb above the nipple and areola and with her first finger below the areola opposite the thumb.Other fingers should support the breast.
• Mother should press her breast behind the nipple pressing on the lactiferous sinuses beneath the areola.
• Mother should press similarly in all 360 degree so that all the segments of breast is expressed.
• Empty one breast first till the breast empties.Repeat the process on another breast.

STORAGE OF EXPRESSED BREAST MILK

Expressed Breast Milk can be stored:-

• At room temperature:-for 6 hours
• In refrigerator:-for 24 hours.

STEPS OF CUP/SPOON/PALADAI FEEDING

• Wash your hands thoroughly with 8 steps of handwashing.
• Keep the baby in head elevated position on mother’s lap.
• Keep a cotton cloth around the neck to mop the spillage.
• Take the required amount of expressed breast milk in measuring cup.
• Hold the cup with handle.Don’t touch the milk.
• Keep the tip of the cup at the corner of the mouth and pour a small amount of milk.
• Baby should swallow the milk actively and slowly.
• If the baby doesn’t accept and swallow, arouse the baby with gentle stimulation on foot and behind the ear.
• While measuring the milk intake, deduct the amount of milk left in the cup and approximate quantity of spill.
• Wash the cup with soap and water and put in boiled hot water for 20 minutes to sterilize before next feed.

AMOUNT OF FEED VOLUME

At full feed the amount that should be given would be 200ml for each kilogram of body weight in a day. It will give enough calories and most of the macronutrients to meet the nutritional needs of the LBW.However, supplementation with Vitamins, Iron and Calcium-Phosphorus should be done.

The feed 200ml/kg /day should be given by cup/paladai/spoon every 2-3hrly that is 8-12 times equally divided feeds.Adequacy of feed can be judged by frequency of urine 8-12 times in 24 hours and weight gain 15-20 grams in a day.